Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
J Card Fail. 2021 Apr;27(4):464-472. doi: 10.1016/j.cardfail.2020.12.012. Epub 2021 Jan 21.
Donor-transmitted atherosclerosis (DTA) and rapidly progressive cardiac allograft vasculopathy (CAV) at 1 year are intravascular ultrasound (IVUS)-derived measures shown to predict adverse cardiovascular outcomes in the setting of early generation immunosuppressive agents. Given the paucity of data on the prognostic value of IVUS-derived measurements in the current era, we sought to explore their association with adverse outcomes after heart transplantation.
This is a retrospective cohort analysis of patients who underwent heart transplantation at our center between January 2009 and June 2016 with baseline and 1-year IVUS. Five IVUS sections were prospectively analyzed for intimal thickness and lumen area. DTA was defined as maximum intimal thickness of 0.5 mm or greater at baseline, and rapidly progressive CAV as an increase in maximum intimal thickness by 0.5 mm or more at 1 year. Our primary analysis assessed the relationship of IVUS and other clinical data on a composite outcome: coronary intervention, CAV stage 2 or 3 (defined by the International Society for Heart and Lung Transplantation 2010 nomenclature), or cardiovascular death. Among 249 patients (mean age 51.0 ± 12.2 years and 74.3% male) included in the analysis, DTA was detected in 118 patients (51.4%). Over a median follow-up of 6.1 years (interquartile range 4.2-8.0 years), 45 patients met the primary end point (23 percutaneous coronary intervention, 11 CAV 2 or 3, and 11 cardiovascular deaths as first event). DTA and rapidly progressive CAV were not associated with the primary end point, all-cause mortality, or retransplantation. In an additional analysis including post-transplant events, incident rejection was strongly associated with poor outcomes, although cytomegalovirus infection was not.
In this contemporary cohort, IVUS-derived DTA and rapidly progressive CAV were not associated with medium- to long-term adverse events after heart transplantation.
供体传播的动脉粥样硬化（DTA）和 1 年内快速进展的心脏移植物血管病（CAV）是血管内超声（IVUS）衍生的指标，在早期免疫抑制剂治疗中可预测不良心血管结局。鉴于当前时代 IVUS 衍生指标预后价值的数据有限，我们试图探讨其与心脏移植后不良结局的关系。
这是一项回顾性队列分析，纳入 2009 年 1 月至 2016 年 6 月在我们中心接受心脏移植的患者，这些患者基线和 1 年时均进行 IVUS 检查。前瞻性分析了 5 个 IVUS 节段的内膜厚度和管腔面积。DTA 的定义为基线时最大内膜厚度≥0.5mm，快速进展性 CAV 定义为 1 年内最大内膜厚度增加≥0.5mm。我们的主要分析评估了 IVUS 和其他临床数据与复合结局（冠状动脉介入治疗、国际心肺移植学会 2010 年命名法定义的 CAV 2 或 3 期、或心血管死亡）的关系。在纳入分析的 249 例患者（平均年龄 51.0±12.2 岁，74.3%为男性）中，118 例（51.4%）检测到 DTA。在中位随访 6.1 年（四分位距 4.2-8.0 年）期间，45 例患者达到主要终点（23 例经皮冠状动脉介入治疗、11 例 CAV 2 或 3、11 例心血管死亡作为首发事件）。DTA 和快速进展性 CAV 与主要终点、全因死亡率或再次移植均无关。在包括移植后事件的附加分析中，排斥反应的发生与不良结局密切相关，而巨细胞病毒感染则不然。
在本当代队列中，IVUS 衍生的 DTA 和快速进展性 CAV 与心脏移植后中至长期不良事件无关。
